Provider Demographics
NPI:1699768960
Name:GREENBELT HOME CARE
Entity type:Organization
Organization Name:GREENBELT HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BS
Authorized Official - Phone:641-939-8444
Mailing Address - Street 1:1506 EDGINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ELDORA
Mailing Address - State:IA
Mailing Address - Zip Code:50627-1624
Mailing Address - Country:US
Mailing Address - Phone:641-939-8444
Mailing Address - Fax:
Practice Address - Street 1:1506 EDGINGTON AVE
Practice Address - Street 2:
Practice Address - City:ELDORA
Practice Address - State:IA
Practice Address - Zip Code:50627-1624
Practice Address - Country:US
Practice Address - Phone:641-939-8444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA67056OtherBLUE CROSS BLUE SHIELD
IA0670869Medicaid
IA0670869Medicaid